Emergency department visits increase in Massachusetts

Emergency physicians warn that the national health reform law, which is based on the state's overhaul, could further stress EDs.

By Doug Trapp — Posted July 21, 2010

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Covering more people in Massachusetts didn't reduce the number of people visiting emergency departments, according to a report released in late June by the Massachusetts Division of Health Care Finance and Policy.

ED visits in Massachusetts increased between 1.5% and 2.4% annually between fiscal years 2004 and 2008, after adjusting for population changes. Roughly 3 million people visited emergency departments in the state in 2008.

Many in Massachusetts had expected ED visits to decrease as previously uninsured people gained coverage, according to Alice Coombs, MD, president of the Massachusetts Medical Society. The Commonwealth Connector reforms -- implemented in 2006 -- increased coverage through a combination of public program expansions, private coverage subsidies and a requirement that nearly all individuals have health insurance. The law lowered the percentage of uninsured people in the state to 5.5% in 2008, down from an average of 10.7% between 2003 and 2005, according to U.S. Census Bureau estimates.

But accessing a primary care physician has become more difficult in many parts of Massachusetts since its health reforms were implemented. "You can have insurance, but unless you can get to a physician, it's like having a check that can't be cashed," Dr. Coombs said.

The ED visit increases did not vary dramatically between different types of hospitals, the report found. However, visits in western Massachusetts increased twice as fast as the other four regions of the state.

The ED visit statistics should be analyzed to find out who is seeking care there and why, Dr. Coombs said. Only 19% of the visitors were admitted to hospitals, while the rest were discharged. Studies have found that the uninsured are not more likely to seek care in EDs than people with coverage. The same finding came from a June report by the Centers for Disease Control and Prevention's National Center for Health Statistics.

The national health reform law will improve access to EDs by requiring health plans in forthcoming health insurance exchanges to cover patients based on their symptoms, not their final diagnoses, according to American College of Emergency Physicians President Angela Gardner, MD. The law also is expected to expand public or private coverage to about 32 million people, reducing the number of uninsured Americans to 23 million by 2019, according to the Congressional Budget Office.

"This means critical problems facing emergency patients are not going away," Dr. Gardner said.

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